The Virus That Owns the World

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The virologist bears no grudge against the virus that causes half a million cervical cancers worldwide every year and now is blamed for a rise in head and neck cancers so surprisingly sharp that it may presage an imminent epidemic among U.S. baby boomers.

Revered for his Zen-like attitude as well as a body of research that has spanned six decades and spawned stunning discoveries about HPV’s cancer-causing ways, Shah simply is not the type to harbor ill will. Not against anyone or anything. Not even a bug that currently infects about 79 million Americans and will infect, at some point in their lives, almost every sexually active person. Especially not a bug that’s so successfully infectious.

In fact, Shah respects HPV. Not in the arched-eyebrow way you would an archrival, but with a fondness that belies kinship. A mere genetic snippet, and therefore in need of others’ cells to live, HPV just wants to communicate bits of itself. Survival requires transmission, replication.

“The viruses are not devious,” says Shah, his contagious smile conveying empathy. Papillomaviruses, he explains, have co-existed quite peacefully with humans throughout time and relatively rarely do harm.

“They own this world as much as we do. Don’t you think?”

If anyone understands HPV, it’s Shah, DrPH ’63, MPH ’57. In addition to having written the chapter on papillomaviruses in the definitive text Fields Virology, Shah gets HPV on an altogether different level, master practitioner that he is of human-to-human transmission of knowledge. During his tenure at Hopkins—57 years and counting—his scientific notions have spread over decades and across continents as his protégés instruct students, and now their students teach successive generations of HPV experts, all of whom embody and expand on Shah’s vision.

The 84-year-old Shah has mentored and collaborated with a who’s who of HPV, from upstart investigators to Harald zur Hausen—he won the Nobel Prize in 2008 for his role in the discovery of human papillomaviruses causing cervical cancer.

Their quarry, HPV, is a sprawling family with 150-plus different virus types identified, about 40 of which are sexually transmitted. HPV causes warts; the harmless kind that kids commonly get on their hands, as well as the genital warts that annually afflict about 360,000 sexually active people in the U.S. HPV contains two oncogenes, E6 and E7, which disrupt cell cycle control and produce cancers. Still, only a few high-risk members of this mostly benign family ever do cause trouble. One (HPV16) alone accounts for 50 percent of all cervical cancers and most head and neck cancers.

Identifying HPV11 as the cause of laryngeal papilloma in 1982 was one of Shah’s early successes. His career is linked with all the major HPV milestones, the headiest of which is rendering cervical cancer preventable. In 1999, Shah proved that HPV is responsible for essentially 100 percent of cervical cancers in all parts of the world. It’s the only example of a major human cancer that has a single cause—a fact that led to the development of a preventive vaccine recommended for adolescents since 2006. A “completely effective vaccine,” Shah notes, albeit one that’s still too expensive for use in Asia, Latin America and Africa where most of the 500,000 new cases of cervical cancer occur each year, and 200,000 people die annually from the disease.

It’s Shah’s habit to slough off accolades and extend credit to colleagues whom he refers to—no matter whether they are grad students or Nobel laureates—by first and last names as well as courtesy titles: “Dr. Patti Gravitt,” for instance.

A Shah protégé, Gravitt, PhD ’02, MS, is now vice dean at Perdana University in Kuala Lumpur and an associate professor in Epidemiology at the Bloomberg School. She and Shah recently co-authored a study that makes the case for a new self-screening strategy in developing nations. They argue that millions of women worldwide who don’t get screened regularly would be able to detect cervical cancers early enough for treatment if this kind of strategy were in place. Ninety percent of those screened, Shah says, would know without ever leaving home that they are not at risk; 10 percent would know they need to go to a clinic for further evaluation.

This latest paper of Shah’s reveals an unrealized dream: “What would I still like to do?” he asks. “Implement an HPV-screening method in India (relying on leadership in that country) which shows this method is both reliable and possible.”

Shah’s great strength, Gravitt explains, is keeping his eye on the public health focus: “Everything he does is directed toward trying to make sure we don’t get distracted by some random detail. Everything comes back to: Does it matter? Does it save lives? A lot of the work we did together was to develop methods to better detect and screen for HPV; to build a better mousetrap. Keerti’s push now is to get people to use the mousetrap.”